Understanding Medicare So You Don't Have To Figure It Out Alone
Medicare is complex, confusing, and full of enrollment windows that can cost you if you miss them. Our advisors help seniors and their families navigate every part — from initial enrollment to choosing the right plan.
Why Medicare Guidance Matters
Medicare covers millions of Americans 65 and older, yet most people enter the system without fully understanding what they're signing up for — or what they're missing. Wrong plan choices, missed enrollment windows, and coverage gaps can cost thousands of dollars a year. We help you get it right the first time.
The Four Parts of Medicare
Inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
Most people pay $0 premium if they or their spouse paid Medicare taxes for at least 10 years.
Doctor visits, outpatient care, preventive services, durable medical equipment, and some home health services.
Standard premium is $174.70/month in 2024 (higher for higher incomes).
All Part A and B benefits through a private insurer, often with added benefits like dental, vision, and hearing.
Varies by plan — many have $0 premium but may have network restrictions.
Prescription medications through private insurance plans approved by Medicare.
Premiums vary by plan, typically $20–$60/month.
Enrollment Windows — Don't Miss Them
Missing an enrollment window can mean paying a permanent penalty or waiting months for coverage to begin.
Initial Enrollment Period (IEP)
7-month window: 3 months before your 65th birthday, your birthday month, and 3 months afterYour first opportunity to enroll in Medicare Parts A and B. Missing this window without qualifying coverage triggers late enrollment penalties.
General Enrollment Period (GEP)
January 1 – March 31 each yearFor those who missed their IEP. Coverage begins July 1. A late enrollment penalty may apply.
Special Enrollment Period (SEP)
8 months after losing employer coverageIf you or your spouse had employer-sponsored health insurance, you may qualify for a Special Enrollment Period when that coverage ends.
Annual Enrollment Period (AEP)
October 15 – December 7 each yearSwitch between Original Medicare and Medicare Advantage, or change your Part D drug plan. Changes take effect January 1.
Original Medicare vs. Medicare Advantage
Original Medicare
Advantages
- See any doctor or hospital that accepts Medicare nationwide
- No referrals needed for specialists
- Predictable coverage structure
- Works well with Medigap supplemental plans
Considerations
- No cap on out-of-pocket costs without a Medigap plan
- No dental, vision, or hearing coverage
- Requires separate Part D drug plan
Medicare Advantage
Advantages
- Often includes dental, vision, hearing, and fitness benefits
- Annual out-of-pocket maximum protects against catastrophic costs
- Many plans have $0 premium
- May include transportation and meal delivery benefits
Considerations
- Network restrictions — must use in-network providers
- Prior authorization required for many services
- Plans change annually — benefits may shift year to year
Medigap: Filling the Gaps in Original Medicare
Original Medicare leaves significant cost-sharing gaps — deductibles, coinsurance, and no out-of-pocket maximum. Medigap (Medicare Supplement) plans are sold by private insurers to cover these gaps. Plans are standardized by letter (Plan G and Plan N are the most popular), so you can compare them apples-to-apples across carriers.
Low-Income Programs: Extra Help & Medicaid
Extra Help (Low Income Subsidy)
A federal program that helps pay Part D premiums, deductibles, and copays for people with limited income and resources. Can save $5,000+ per year on drug costs.
Medicare Savings Programs
State programs that help pay Medicare premiums, deductibles, and coinsurance for qualifying low-income beneficiaries.
Dual Eligibility (Medicare + Medicaid)
Seniors who qualify for both Medicare and Medicaid ("dual eligibles") may have most or all of their healthcare costs covered. Special plans exist to coordinate both programs.
Medicare Questions? We Have Answers.
Our advisors help you compare plans, understand your options, and enroll with confidence — at no cost to you.